Disorders of Lymphatic Architecture and Flow in Critical Illness.

Objectives

To provide a narrative review of disordered lymphatic dynamics and its impact on critical care relevant condition management.

Data sources

Detailed search strategy using PubMed and Ovid Medline for English language articles (2013-2023) describing congenital or acquired lymphatic abnormalities including lymphatic duct absence, injury, leak, or obstruction and their associated clinical conditions that might be managed by a critical care medicine practitioner.

Study selection

Studies that specifically addressed abnormalities of lymphatic flow and their management were selected. The search strategy time frame was limited to the last 10 years to enhance relevance to current practice.

Data extraction

Relevant descriptions or studies were reviewed, and abstracted data were parsed into structural or functional etiologies, congenital or acquired conditions, and their management within critical care spaces in an acute care facility.

Data synthesis

Abnormal lymph flow may be identified stemming from congenital lymphatic anomalies including lymphatic structure absence as well as acquired obstruction or increased flow from clinical entities or acute therapy. Macro- and microsurgical as well as interventional radiological techniques may address excess, inadequate, or obstructed lymph flow. Patients with deranged lymph flow often require critical care, and those who require critical care may concomitantly demonstrate deranged lymph flow that adversely impacts care.

Conclusions

Critical care clinicians ideally demonstrate functional knowledge of conditions that are directly related to, or are accompanied by, deranged lymphatic dynamics to direct timely diagnostic and therapeutic interventions during a patient's ICU care episode.

COI Statement

Dr. Itkin received support for article research from the National Institutes of Health. Dr. Pascual is the President-elect of the Society of Critical Care Medicine and an editorial board member for Critical Care Medicine. Dr. Chang is the Treasurer of the Society of Critical Care Medicine, a former Associate Editor for Critical Care Medicine (2021–2023), an editorial board member for Critical Care Medicine, and a past-President of the Neurocritical Care Society; she received funding from the Society of Critical Care Medicine, Neurocritical Care Society, American Board of Internal Medicine Critical Care Medicine, and American Board of Psychiatry and Neurology. Dr. Bass is a current member of the Executive Board of the European Society of Trauma and Emergency Surgery and an editorial board member for the European Journal of Trauma and Emergency Surgery. Dr. Kovach received funding from Becton Dickinson, Integra, and Checkpoint Surgical. Dr. Kaplan is a past-President of the Society of Critical Care Medicine (2020–2021), an Associate Editor for Critical Care Explorations, and an editorial board member for Critical Care Medicine; he received funding for expert testimony from several law firms. The remaining authors have disclosed that they do not have any potential conflicts of interest.

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